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Repro Final > OB Complications II-Castro > Flashcards

OB Complications II-Castro Flashcards

1
Q

What is preterm labor (PTL)?

A

labor (regular uterine contractions and progressive cervical change) before 37 completed weeks of gestation

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2
Q

What is Premature Rupture of Membranes (PROM)? How is this different from PPROM (preterm premature rupture of membranes)?

A
  • PROM=rupture of the chorioamniotic membranes prior to the onset of labor
  • PPROM=PROM before 37 weeks of gestation completed
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3
Q

What factors are associated with pre-term labor?

A
  • PROM
  • Infection
  • Uterine overdistension (multiple gestation, polyhydramnios)
  • Uterine myomas
  • Prior history of PTL
  • maternal substance abuse
  • placental abruption and previa
  • uterine anomalies
  • cervical insufficiencies
  • iatrogenic (not well dated and induce labor early)
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4
Q

What medication can be given to prevent PTL in a pt who has had a prior PTL before 35 weeks? When should this medication be given?

A

progesterone supplementation (daily vaginal suppositories)

or weekly IM 17 alpha hydroxy progesterone acetate

in the second trimester until 36 weeks

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5
Q

What should be included in the evaluation of a pt with suspected PTL?

A
  • detailed hx including presenting symptoms
  • monitoring and uterine palpation to determine strength of contractions
  • spec exam –> look for ruptured membranes and culture for bacteria (GC, chlamydia, BV, group B strep)
  • test cervico-vaginal secretions for fetal fibronectin if > 50 –> high risk for pre-term birth
  • vag US for cervical length
  • evaluate fetus
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6
Q

How should preterm labor be treated?

A
  • determine if there is a reason the fetus should be delivered (i.e. IUGR)
  • address treatable causes (UTI)
  • hydrate
  • administer tocolytics to stop contractions and monitor FHR
  • Betamethasone to accelerate fetal lung maturity if < 34 weeks)
  • Antibiotics for strep pending cultures
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7
Q

What are the common Tocolytics used for PTL? What maternal SE do these all have?

A
  • Beta-agonists (Terbutaline used most)
  • magnesium sulfate
  • PG synthetase inhibitors (indomethacin)
  • CCB

SE: pulmonary edema
indomethacin can cause premature closure of the ductus–> fetal renal problems

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8
Q

What is chorioamnionitis? What is the normal treatment?

A
  • maternal complication of PROM
  • Diagnose clinically based on maternal fever (>38 degrees), uterine tenderness, maternal or fetal tachycardia and occasionally purulent cervical discharge
  • associated with preterm labor/dysfunctional labor

-Treatment:
broad spectrum antibiotics AND treatment of the fetus

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9
Q

What are some fetal complications of PROM/PPROM?

A
  • Intrauterine infection predisposing to neonatal sepsis
  • Prematurity–from spontaneous preterm labor or indicated preterm delivery (in the presence of infection or umbilical cord compression)
  • Contraction deformities, amniotic band syndrome and pulmonary hypoplasia-usually 2nd tri PPROM (oligohydramnios)
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10
Q

What are some risk factors for PROM?

A
  • smoking
  • previous history of PROM
  • hx of preterm delivery
  • short cervix
  • multiple gestation
  • polyhydramnios
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11
Q

What is the relationship between PPROM and PTL?

A
  • either may cause the other

- the earlier in gestation PPROM occurs, the longer the latent phase (time between rupture and onset of labor)

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12
Q

What PE findings indicate a ruptured membrane?

A

-history of clear, watery vaginal discharge

on speculum exam:

  • vaginal pooling
    • nitrazine test (pH is alkaline and turned the paper blue)
    • “ferning test” (ONLY cervical mucus will fern)
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13
Q

What should the physician avoid in PROM?

A

digital cervical exam (unless in labor) because of increased risk of introducing infection

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14
Q

What should be done for a woman with PROM with no evidence of infection, labor, or cord compression and the fetus is significantly premature?

A
  • hold off on delivery
  • betamethasone to enhance lung maturity
  • antibiotics from group B strep tx if needed
  • daily fetal and maternal assessment for signs of labor, infection or non-reassuring fetal status
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15
Q

When should tocolytics be used in PROM and preterm labor?

A

ONLY if there is no evidence of infection and the fetus (<34 weeks) might benefit from it

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16
Q

When should PROM be delivered?

A

> 34 weeks gestation

  • chorioamnionitis
  • fetal cord compressions or cord prolapse
17
Q

What is post-term pregnancy? What is the most common cause?

A
  • a pregnancy duration greater than or equal to 42 weeks
  • most common is due to inaccurate dating or delayed ovulation

(can also be caused by fetal adrenal hypoplasia (lack of cortisol signal), placental steroid sulfates deficiency or anencephaly)

18
Q

What are the complications of post-term pregnancy?

A
  • *(critical) meconium aspiration syndrome –> cause CP and neurodevelopment problems -fetal postmaturity or dysmaturity syndrome -often have metabolic imbalance (hypoglycemia and hyperbilirubinemia)
  • macrosomia
  • placental dysfunction or insufficiency
  • oligohydramnios, umbilical cord compression
19
Q

What should you monitor in a post-term pregnancy if you decide to not proceed with delivery?

A
  • daily kick counts
  • 2x/week non-stress tests
  • 2x/week US for AFI (amniotic fluid index)
20
Q

What is oligohydramnios? What are some causes?

A

-AFI less than 5.

Causes:

  • PROM
  • renal/bladder anomalies (ie renal agenesis or potters syndrome, urethral agenesis)
  • Utero-placental insufficiency (ie IUGR, hypertension/preeclampsia or other causes of vascular disease, maternal drug use)
  • Post-term pregnancy
21
Q 
You review an obstetrical ultrasound report that says the estimated fetal weight is less that the 10th percentile for gestational age.  Which of the following pregnancy complications can reasonably be excluded from your differential diagnosis:
A.	Preeclampsia
B.	Inadequate maternal weight gain
C.	Fetal chromosomal anomalies
D.	Maternal alcohol use
E.	Gestational diabetes
A

E. Gestational diabetes

22
Q 
A 34-year-old at 39 weeks of gestation complains of a watery vaginal discharge.  A speculum exam shows vaginal “pooling”, the nitrazine test is positive and the “ferning test” is positive.  What is the most likely diagnosis?
A.	Bacterial vaginosis
B.	Urinary incontinence
C.	Premature rupture of membranes
D.	Chlamydia cervicitis
E.	Recent coitus
A

C. Premature rupture of membranes

23
Q 
A newborn at 43 weeks of gestation is admitted to the NICU with meconium aspiration syndrome . Which of the following anomalies would most likely be present in this neonate?
A. Congenital adrenal hypoplasia
B. Renal agenesis
C. Trisomy 21
D. A myelomeningocele
E. An omphalocele
A

A. Congenital adrenal hypoplasia

24
Q 
You administer Betamethasone to a 23-year-old at 30 weeks gestation in preterm labor in order to:

A.	Accelerate fetal lung maturity
B.	Stop uterine contractions
C.	Prevent fetal hypoxia
D.	Treat chorioamnionitis
E.	Prolong the pregnancy
A

A. Accelerate fetal lung maturity

Repro Final (17 decks)

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